Berkshire Diabetic Eye Screening Service

1. Berkshire Diabetic Eye Screening Service Stephanie Holland, Service Manager and Dr Philip Haynes, GP Brookside Practice

2. Aims:To reduce the risk of sight loss amongst people with diabetes by a systematic screening programme for diabetic retinopathy that fully complies with the national standards set by the NHS Diabetic Eye Screening Programme (NHS DESP).To reduce new blindness due to retinopathy amongst people with diabetes, by the prompt identification and effective treatment of sight threatening retinopathy, at the appropriate stage during the disease process.

3. Educational DVD ..\..\Operational Issues\DVD\Retinopathy-part1_WMV 480p (16x9).wmv

4. Process • - 7 weeks The scheduled visit to GP Surgery if confirmed. • - 6 weeks A Patient List is sent to the GP Surgery • - 5 weeks A Patient List is returned to the BDESP Office

5. - 4 weeks DES generates invitation letters • - 3 weeks to - 2 weeks Patient phones for an appointment BDESP Office open from 9am to 8pm Monday to Friday • - 3 days Text messages sent or reminder telephone call made

6. - 1 week BDESP office faxes completed appointment lists to GP Practices and prepares patient information. GP Practices to contact patient who have not made an appointment • Week of Screening Visit takes place • + 1 week to + 3 weeks Images graded and assessed • + 3 weeks Reminder letters sent

7. + 4 weeks to + 5 weeks BDESP office issues results and makes referral BDESP notify GP Practice of patients that did not respond to two invitations. GP Practice to follow up with patients • + 5 weeks • BDESP office monitors referrals to ensure that patients are seen within timescales and monitor discharges to ensure patients do not ‘slip through the net’ (Failsafe)

8. Grading Pathway

9. NSC Retinopathy Grading Standard Retinopathy (R) Level 0 None Level 1 Background Level 2 Pre-proliferative Level 3s Proliferative – stable treated Level 3a Proliferative - active Maculopathy (M) Level 0 None Level 1 Features present Photocoagulation (P) Level 0 None evidence Level 1 Focal / grid to macula or peripheral scatter Unclassifiable (U) An image set that cannot be graded

10. What is Failsafe? Failsafe is a back-up mechanism which ensures that when something goes wrong in a system, processes are in place to identify what is going wrong and action follows to ensure that there is a safe outcome. The NHS Screening Programme Lead, general practitioners, Clinical Lead, Office Manager, screeners taking photographs and graders all have failsafe responsibilities.

11. Image of a Screening Session

12. Other websites: www.youtube.com/watch?v=gi_77R21ZlE www.diabeticeye.screening.nhs.uk (NHS Diabetic Eye Screening Programme (NDESP))

13. Statistics (12 months ending March 2013)

14. National Changes in 2013/14 • Why the change • What is different • Pathway • Commissioning • Exclusions & Suspensions

15. Screening Principles • Important Problem • Accepted Treatment • Recognisable Latent / Early Stage • Suitable / Acceptable Test • Cost Effective • Continuing Process

16. Diabetic Eye Disease • Retinopathy – Non-Proliferative - Proliferative • Maculopathy • Cataracts • Retinal Vein Occlusion • Retinal Detachment

17. Treatment for Diabetic Eye Disease At Home At Hospital Laser Intravitreal Injections - Steroids - VEGF inhibitors 3. Vitrectomy • Blood Glucose (caution with rapid improvement) • HBA1C < 58 mmol/mol • Blood Fats • Total Chol <4mmol/l • LDL Chol < 2mmol/l • HDL Chol >1.2mmol/l • Triglycerides <1.7mmol/l • Blood pressure • BP < 130/80

18. NDA READ Codes • 3129. Eye fundus photography • 68A7. Diabetic retinopathy screening • 312F. Camera fundoscopy • 58C1. Retinal photography • 68A8. Digital retinal screening • 9N2f. Seen by retinal screener

19. Who isn’t being screened? • Screening rates higher in the Elderly, and those with lower HbA1C and BP • Screening rates lower in : • Type 1 diabetes • Longer history of diabetes • Younger People Eye Screening in Gloucester(Diabetes and Primary Care Vol 14 No 5 2012)

20. Why not screened? • 22% Thought attending optician /optometrist or even ophthalmologist was sufficient • 18% Did not receive invitation • 12% Health problems • 8% too busy • 8% transport problems • 7% Cannot remember • 6% On holiday • 6% At work • 4% concerned about procedure • Remainder: Dementia, forgot to make appointment, language difficulty, thought vision was ok, family illness, forgot to go. Eye Screening in Gloucester(Diabetes and Primary Care Vol 14 No 5 2012)

21. Top Tips • Flag Reminders on screen with BDES phone number (0118 949 5152) and office opening hours (2 – 8 pm) • Check Ophthalmology Letters for patients who have not been screened • Mobile phone numbers – text reminders

22. Key Messages • Education – Asymptomatic • Organisation – Work together with BDES • READ Coding – 68A7. Diabetic Retinopathy Screening

23. Questions?